Biocompatible polymeric contrast agents and radiopaque materials for medical services

ABSTRACT

In accordance with the present invention, a high intensity radiopaque contrast agent is disclosed. The agent may be coated on or incorporated within bulk materials, which may then be subsequently utilized to fabricate a radiopaque medical device. Primary effects through chemistry include higher radiopaque concentrations per unit weight of the radiopaque element or agent. Secondary effects include selective placement of the radiopaque elements which may further enhance the radiopacity of the device with reduced requirements of the radiopaque agent. Such a radiopaque contrast agent may be produced in various forms such as a dendrimer and/or incorporated as the end groups of polymeric chain. In addition one can incorporate biological and/or pharmaceutical agents in combination with the present invention.

CROSS REFERENCE TO RELATED APPLICATIONS

This is a divisional application of U.S. patent application Ser. No.12/051,009 filed on Mar. 19, 2008, now U.S. Pat. No. 8,197,796, which isa continuation of U.S. patent application Ser. No. 11/368,688 filed onMar. 6, 2006, now abandoned, which claims priority under 35 U.S.C.§119(e) of U.S. Provisional Patent Application No. 60/662,957 filed onMar. 18, 2005.

1. FIELD OF THE INVENTION

The present invention relates to intravascular devices used in medicaltreatment and procedures. More specifically, the present inventionrelates to a new class of organic high intensity X-ray contrast agentssuitable for enhancing the imaging of medical devices, particularlypolymeric medical devices and polymeric coatings being fabricated from apolymer with the contrast agent dispersed within, conjugated at one orboth ends of the polymers, as well as the method of manufacture of suchmaterials and devices.

2. DISCUSSION OF THE RELATED ART

Recently, transluminal prostheses have been widely used in the medicalarts for implantation in blood vessels, biliary ducts, or other similarorgans of living body. These prostheses are commonly known as stents andare used to maintain, open, or dilate tubular structures. An example ofa commonly used stent is given in U.S. Pat. No. 4,733,665 filed byPalmaz on Nov. 7, 1985, which is hereby incorporated herein byreference. Such stents are often referred to as balloon expandablestents. Typically the stent is made from a solid tube of stainlesssteel, although other metallic materials have been utilized. Thereafter,a series of cuts are made in the wall of the stent. The stent has afirst smaller diameter, which permits the stent to be delivered throughthe human vasculature by being crimped onto a balloon catheter. Thestent also has a second, expanded diameter, upon application of aradially, outwardly directed force, by the balloon catheter, from theinterior of the tubular shaped member.

However, one concern with such stents is that they are often impracticalfor use in some vessels such as the carotid artery. The carotid arteryis easily accessible from the exterior of the human body, and is closeto the surface of the skin. A patient having a balloon expandable stentmade from stainless steel or the like, placed in their carotid artery,might be susceptible to severe injury through day-to-day activity. Asufficient force placed on the patient's neck could cause the stent tocollapse, resulting in injury to the patient. In order to prevent this,self-expanding stents have been proposed for use in such vessels.Self-expanding stents act like springs and will recover to theirexpanded or implanted configuration after being crushed.

One type of self-expanding stent is disclosed in U.S. Pat. No.4,655,771, which stent has a radially and axially flexible, elastictubular body with a predetermined diameter that is variable under axialmovement of the ends of the body relative to each other and which iscomposed of a plurality of individually rigid but flexible and elasticthread elements defining a radially self-expanding helix. This type ofstent is known in the art as a “braided stent” and is so designatedherein. Placement of such stents in a body vessel can be achieved by adevice that comprises an outer catheter for holding the stent at itsdistal end, and an inner piston that pushes the stent forward once it isin position.

However, braided stents have many disadvantages. They typically do nothave the necessary radial strength to effectively hold open a diseasedvessel. In addition, the plurality of wires or fibers used to make suchstents could become dangerous if separated from the body of the stent,where they could pierce through the vessel. Therefore, there has been adesire to have a self-expanding stent that is cut from a tube of metal,which is the common manufacturing method for many commercially availableballoon-expandable stents. In order to manufacture a self-expandingstent cut from a tube, the alloy used would preferably exhibitsuperelastic or pseudoelastic characteristics at body temperature, sothat it is crush recoverable.

The prior art makes reference to the use of alloys such as Nitinol(Ni—Ti alloy), which have shape memory and/or superelasticcharacteristics, in medical devices that are designed to be insertedinto a patient's body. The shape memory characteristics allow thedevices to be deformed to facilitate their insertion into a body lumenor cavity and then be heated within the body so that the device returnsto its original shape. Superelastic characteristics, on the other hand,generally allow the metal to be deformed and restrained in the deformedcondition to facilitate the insertion of the medical device containingthe metal into a patient's body, with such deformation causing the phasetransformation. Once within the body lumen, the restraint on thesuperelastic member can be removed, thereby reducing the stress thereinso that the superelastic member can return to its original un-deformedshape by the transformation back to the original phase.

Alloys having shape memory/superelastic characteristics generally haveat least two phases. These phases are a martensite phase, which has arelatively low tensile strength and which is stable at relatively lowtemperatures, and an austenite phase, which has a relatively hightensile strength and which is stable at temperatures higher than themartensite phase.

Shape memory characteristics are imparted to the alloy by heating themetal at a temperature above which the transformation from themartensite phase to the austenite phase is complete, i.e. a temperatureabove which the austenite phase is stable (the A_(f) temperature). Theshape of the metal during this heat treatment is the shape “remembered.”The heat-treated metal is cooled to a temperature at which themartensite phase is stable, causing the austenite phase to transform tothe martensite phase. The metal in the martensite phase is thenplastically deformed, e.g. to facilitate the entry thereof into apatient's body. Subsequent heating of the deformed martensite phase to atemperature above the martensite to austenite transformation temperaturecauses the deformed martensite phase to transform to the austenitephase, and during this phase transformation the metal reverts back toits original shape if unrestrained. If restrained, the metal will remainmartensitic until the restraint is removed.

Methods of using the shape memory characteristics of these alloys inmedical devices intended to be placed within a patient's body presentoperational difficulties. For example, with shape memory alloys having astable martensite temperature below body temperature, it is frequentlydifficult to maintain the temperature of the medical device containingsuch an alloy sufficiently below body temperature to prevent thetransformation of the martensite phase to the austenite phase when thedevice was being inserted into a patient's body. With intravasculardevices formed of shape memory alloys having martensite-to-austenitetransformation temperatures well above body temperature, the devices canbe introduced into a patient's body with little or no problem, but theymust be heated to the martensite-to-austenite transformationtemperature, which is frequently high enough to cause tissue damage.

When stress is applied to a specimen of a metal such as Nitinolexhibiting superelastic characteristics at a temperature above which theaustenite is stable (i.e. the temperature at which the transformation ofmartensite phase to the austenite phase is complete), the specimendeforms elastically until it reaches a particular stress level where thealloy then undergoes a stress-induced phase transformation from theaustenite phase to the martensite phase. As the phase transformationproceeds, the alloy undergoes significant increases in strain but withlittle or no corresponding increases in stress. The strain increaseswhile the stress remains essentially constant until the transformationof the austenite phase to the martensite phase is complete. Thereafter,further increases in stress are necessary to cause further deformation.The martensitic metal first deforms elastically upon the application ofadditional stress and then plastically with permanent residualdeformation.

If the load on the specimen is removed before any permanent deformationhas occurred, the martensitic specimen will elastically recover andtransform back to the austenite phase. The reduction in stress firstcauses a decrease in strain. As stress reduction reaches the level atwhich the martensite phase transforms back into the austenite phase, thestress level in the specimen will remain essentially constant (butsubstantially less than the constant stress level at which the austenitetransforms to the martensite) until the transformation back to theaustenite phase is complete, i.e. there is significant recovery instrain with only negligible corresponding stress reduction. After thetransformation back to austenite is complete, further stress reductionresults in elastic strain reduction. This ability to incur significantstrain at relatively constant stress upon the application of a load, andto recover from the deformation upon the removal of the load, iscommonly referred to as superelasticity or pseudoelasticity. It is thisproperty of the material which makes it useful in manufacturing tube cutself-expanding stents.

The prior art makes reference to the use of metal alloys havingsuperelastic characteristics in medical devices that are intended to beinserted or otherwise used within a patient's body. See for example,U.S. Pat. No. 4,665,905 (Jervis) and U.S. Pat. No. 4,925,445 (Sakamotoet al.). However, the prior art has yet to disclose any suitabletube-cut self-expanding stents. In addition, many of the prior artstents lacked the necessary rigidity or hoop strength to keep the bodyvessel open. In addition, many of the prior art stents have largeopenings at their expanded diameter. The smaller the openings are on anexpanded stent, the more plaque or other deposits it can trap betweenthe stent and the vessel wall. Trapping these deposits is important tothe continuing health of the patient in that it helps prevent plaqueprolapse into the vessel, restenosis of the vessel it is implanted into,and strokes caused by the release of embolic particles into thebloodstream.

One additional concern with stents, and with other medical devices, isthat they may exhibit reduced radiopacity under X-ray fluoroscopy. Toovercome this problem, it is common practice to attach markers made fromhighly radiopaque materials to the stent, or to use radiopaque materialsin plating or coating processes. Those materials are typically gold,platinum, or tantalum. The prior art makes reference to these markers orprocesses in U.S. Pat. No. 5,632,771 (Boatman et al), U.S. Pat. No.6,022,374 (Imran), U.S. Pat. No. 5,741,327 (Frantzen), U.S. Pat. No.5,725,572 (Lam et al), and U.S. Pat. No. 5,800,526 (Anderson et al).However, due to the relative position of these materials in the galvanicseries versus the position of the base metal of the stent in thegalvanic series, there is a certain challenge to overcome; namely, thatof galvanic corrosion.

In addition, biodegradable stents and stents fabricated from polymericmaterials that avoid the use of metallic materials must still be able tobe visualized under X-ray fluoroscopy. For these types of devices amajor challenge exists in how to impart/increase the radiopacity ofthese devices with out the use of radiopaque markers or coatings. Theprior art makes reference to one such method in U.S. Pat. No. 4,935,019(Papp), in which a radiopaque, polymeric composition suitable forprinting onto surgical fabrics provides an X-ray detectable marker, saidmarker is obtained by dispersing a heavy metal salt such as bariumsulfate in a liquid polymer carrier. In Papp, the barium sulfate has anaverage particle size greater than about 5 microns and is present in anamount of from about 15 to 90% by weight of total solids of saidcomposition. Papp indicates that barium sulfate comprising from about 60to 90% by weight of solids of said composition is preferred. Howeveraddition of barium sulfate in large percentage quantities such as thismay affect the integrity of the base material, reducing strength, andadversely affecting other mechanical properties and characteristics. Inbiodegradable polymers, the impact of radiopaque additives may alsoaffect properties such as degradation rates of bioabsorbable polymers,elasticity, while potentially adding the presence of stress risers inand around any localized concentration of barium sulfate particleswithin the material. Furthermore, inorganic contrast agents such asbarium sulfate and zirconium oxide do not readily dissolve or do noteasily disperse in organic solvents, which are commonly used to dissolvenon-degradable and biodegradable polymers.

Accordingly, there is a need for a radiopaque material or agent that canbe easily added to biostable polymeric and biodegradable polymericmaterials which readily dissolves into the polymer so that the resultingcomposite material is adequately radiopaque and which will not adverselyaffect the material or mechanical properties of the material one desiresto make radiopaque.

BRIEF SUMMARY OF THE INVENTION

The high intensity X-ray contrast agent in accordance with the presentinvention overcomes the disadvantages and shortcomings of what iscurrently available and satisfies the unmet needs of imaging medicaldevices, particularly non-metallic medical devices by maximizing theintensity of the x-ray contrast agent both through primary and secondaryeffects. Primary effects include incorporating the radiopaque elementand maximizing the content of this element in the contrast agent throughchemistry, while secondary effects include optimizing the location ofthe radiopaque element within the polymer. Essentially by selectivelymaximizing and incorporating the iodine content within and dispersedthroughout the polymer one can tune the radiopacity of polymericmaterials to levels previously not available. Moreover, the creation andoptimization of this contrast agent allows for improved processingcharacteristics when combined with polymeric materials and as such mayfurther reduce manufacturing costs while providing a polymeric materialwith improved high intensity radiopacity with a satisfactory degradationprofile.

The present invention relates to a high intensity dendritic orstar-shaped contrast agent suitable for use with implantable polymericmedical devices or for a polymeric coating of an implantable medicaldevice. Multivalent hydroxyl or amine containing organic compounds suchas pentaerythritol, bis-pentaerythritol glycerol, polyhydric mono- anddi-saccharides, etc., can be used to react with an iodine containingaromatic compounds such as 2, 3, 5-triiodobenzoic acid to form such highiodine containing compounds. Each such compound may contain a multipleof three (3) iodine atoms, greatly intensifying the x-ray image of amedical device fabricated from a material containing such a compound.The iodine content in such a high intensity dendritic contrast agent maybe as high as 85% using commercially available dendritic polyamineprecursors.

In an exemplary embodiment of the present invention, the contrast agentmay contain a multiplicity of iodine atoms or bromine atoms or acombination of both in a single molecule in order to enhance the x-rayimage produced by dispersing the agent throughout the material thateither the device will be fabricated from or applied as a coating to thedevice. In accordance with the present invention, the contrast agent canbe constructed from any core of dendrimer containing free functionalgroups such as amine, hydroxyl, sulfhydryl, isocyanate, and result in amolecule containing a multiple of three (3) iodine or bromine or acombination of both atoms with each additional conjugation of smalliodine or bromine containing building block, such as triiodobenzoic acidor as triiodobenzoic acid chloride. When constructed in this fashion,the contrast agent may be substantially soluble in common organicsolvent such as acetone, dimethylacetamide (DMA), dimethylsulfoxide(DMSO), acetone, THF, 1,4-dioxane, DCM etc. and also has substantiallygood miscibility with common organic polymers such as PLGA, PLA etc. Thecontrast agent in accordance with the present invention can form a solidsolution with a polymer matrix that can then form the basis of a medicaldevice. The contrast agent in accordance with the present invention issubstantially biocompatible and can be added to polymer or polymermixtures, and/or inorganic/organic composite materials to enhance itsX-ray image quality.

In another exemplary embodiment of the present invention, the contrastagent may be mixed with the bulk material by various means such assolvent casting, injection and/or compression molding in order to form amedical device or a coating for a medical device. The bulk form can thenbe processed to final size and shape by traditional fabrication methods.Alternatively, the polymeric coating with the contrast agent includedcan be applied to the surface of an implantable medical device employingtraditional coating methods

In yet another exemplary embodiment of the present invention, selectiveincorporation of the contrast agent to a polymeric structure can beaccomplished in a number of ways. By ensuring placement of the contrastagent in certain areas of the polymer structure and not in other areas,additional secondary improvements in radiopacity can be realized withoutaffecting material and/or mechanical properties. One such example isincorporation of the contrast agent at the proximal and distal ends ofthe polymer chain. By utilizing methods such as orientrusion, which mayprovide for a high degree of molecular orientation of the polymer chainswithin the polymer, one can create a polymeric material with highintensity radiopacity at the select portions of the bulk material whichwould be significantly more radiopaque than the surrounding areas wherethe contrast agent was not present. Like wise the selective placement ofthe contrast agents in the coating material can provide one withsecondary benefits similar to those obtained with selective placement ofthe contrast agents in the bulk material.

In yet another exemplary embodiment of the present invention, selectiveincorporation of the contrast agent to a polymeric structure can beaccomplished through a covalent conjugation process at either of thedistal and proximal end, or both ends of a biostable and/orbiodegradable polymer chain. Such polymers with inherent radiopacity canbe used to either build implantable devices or as a coating for animplantable medical device.

Furthermore the incorporation or application of biological and/orpharmaceutical agents with or onto the material can provide additionalbenefits when used in combination with the present invention, and assuch is a further object of this invention. Compounds such as thoseidentified below may be applied as coatings on these devices orincorporated within the polymer and may be used to deliver therapeuticand pharmaceutical agents which may include:anti-proliferative/antimitotic agents including natural products such asvinca alkaloids (i.e. vinblastine, vincristine, and vinorelbine),paclitaxel, epidipodophyllotoxins (i.e. etoposide, teniposide),antibiotics (dactinomycin (actinomycin D) daunorubicin, doxorubicin andidarubicin), anthracyclines, mitoxantrone, bleomycins, plicamycin(mithramycin) and mitomycin, enzymes (L-asparaginase which systemicallymetabolizes L-asparagine and deprives cells which do not have thecapacity to synthesize their own asparagine); antiplatelet agents suchas G(GP) ll_(b)/lll_(a) inhibitors and vitronectin receptor antagonists;anti-proliferative/antimitotic alkylating agents such as nitrogenmustards (mechlorethamine, cyclophosphamide and analogs, melphalan,chlorambucil), ethylenimines and methylmelamines (hexamethylmelamine andthiotepa), alkyl sulfonates-busulfan, nirtosoureas (carmustine (BCNU)and analogs, streptozocin), trazenes-dacarbazinine (DTIC);anti-proliferative/antimitotic antimetabolites such as folic acidanalogs (methotrexate), pyrimidine analogs (fluorouracil, floxuridine,and cytarabine), purine analogs and related inhibitors (mercaptopurine,thioguanine, pentostatin and 2-chlorodeoxyadenosine {cladribine});platinum coordination complexes (cisplatin, carboplatin), procarbazine,hydroxyurea, mitotane, aminoglutethimide; hormones (i.e. estrogen);anti-coagulants (heparin, synthetic heparin salts and other inhibitorsof thrombin); fibrinolytic agents (such as tissue plasminogen activator,streptokinase and urokinase), aspirin, dipyridamole, ticlopidine,clopidogrel, abciximab; antimigratory; antisecretory (breveldin);anti-inflammatory: such as adrenocortical steroids (cortisol, cortisone,fludrocortisone, prednisone, prednisolone, 6α-methylprednisolone,triamcinolone, betamethasone, and dexamethasone), non-steroidal agents(salicylic acid derivatives i.e. aspirin; para-aminophenol derivativesi.e. acetaminophen; indole and indene acetic acids (indomethacin,sulindac, and etodalac), heteroaryl acetic acids (tolmetin, diclofenac,and ketorolac), arylpropionic acids (ibuprofen and derivatives),anthranilic acids (mefenamic acid, and meclofenamic acid), enolic acids(piroxicam, tenoxicam, phenylbutazone, and oxyphenthatrazone),nabumetone, gold compounds (auranofin, aurothioglucose, gold sodiumthiomalate); immunosuppressives: (cyclosporine, tacrolimus (FK-506),sirolimus (rapamycin), azathioprine, mycophenolate mofetil); angiogenicagents: vascular endothelial growth factor (VEGF), fibroblast growthfactor (FGF); angiotensin receptor blockers; nitric oxide donors;antisense oligionucleotides and combinations thereof; cell cycleinhibitors, mTOR inhibitors, and growth factor receptor signaltransduction kinase inhibitors; retenoids; cyclin/CDK inhibitors; HMGco-enzyme reductase inhibitors (statins); and protease inhibitors.

The use of compounds in conjunction with the present invention canprovide distinct clinical advantages over existing therapies and/ordevices. More specifically, compounds that are capable of causing lysisor degradation of the embolic debris can be incorporated into thefiltering portion of the present invention. A factor to consider in theselection of such a compound is the origin of the debris be it thrombus,plaque, atheroma, or any other form representing an embolus. As the meshand or pore size of the filtering aspect of the present inventiondecreases, more embolic material may become trapped in the filteringmechanism of the present invention, thereby increasing the load on thefiltering portion. While small emboli (typically smaller than 100microns) are not a major concern because of the body's natural abilityto enzymatically degrade, digest or lyse the emboli, the embolic load onthe filter itself can be overloaded and result in formation of athrombus if the blood flow is significantly slowed to the point whichallows for a thrombus formation. In this situation the incorporation orapplication of compounds, which can degrade trapped emboli, can bebeneficial. Some exemplary suitable compounds may include: TissuePlasminogen activator (TPA); Streptokinase(SK); Reteplase; Tenecteplase;Urokinase; Lanoteplase; Staphylokinase; and/or Nadroparin(anti-factorXa). In addition, the filtering portion of the present invention mayincorporate an antithrombotic and/or antithrombogenic agent to preventthe formation of a thrombus. Some exemplary compounds may include:Heparin; Fragmin (dalteparin, low MW Heparin); a monoclonal antibodysuch as ReoPro™ (abciximab, antiplatelet antibodies) Acenocoumarol;Anisindione; Dicumarol; Warfarin; Enoxaparin (Lovenox); Anagrelide(Agrylin); Indomethacin (Indocin); Dipyridamole; Clopidogrel; Aggrenox;and/or Coumadin. Furthermore, an affinity-binding compound may also beincorporated with the filtering aspect of the present invention byitself or in combination with other compounds. Affinity-bindingcompounds can promote the binding and/or adhesion of embolic materialthus facilitating entrapment of embolic material and subsequent removalfrom the blood stream. Whether incorporated into the strut or membraneby methods such as chemical surface treatments, bombardment, placementinto reservoirs, or in the case of polymeric struts and membranes,blended with the material itself, or by application of a coating to thestruts and/or membranes with a compound, any identified compound orcombination of identified compounds may be used. Furthermore any numberof compounds may suggest themselves to one who is skilled in the art andmay be utilized in connection with the present invention alone or incombination with other compounds.

The foregoing exemplary embodiments of the present invention provide ahigh intensity radiopaque contrast agent which may be usedindependently, for example as a coating or may be incorporated within apolymeric material to be subsequently fabricated into medical devices inaccordance with the present invention. Moreover, the incorporation ofdrugs and/or agents may be combined with the high intensity contrastagent to realize additional synergistic benefits. As noted above, theincorporation of biological and/or pharmaceutically active agents withthe present invention can be utilized for the additional purposes ofpreventing thrombus formation, promotion of binding, and degradation ofthrombus, all of which provide a patient benefit.

BRIEF DESCRIPTION OF THE DRAWINGS

Aspects of the present invention as well as the preceding informationmay best be understood with reference to the subsequent detaileddescription taken in conjunction with the accompanying exemplarydrawings in which:

FIG. 1 shows the coupling reaction between pentaerythritol and2,3,5-triiodobenzoic acid and the reaction products wherein, SOCl₂ isthe catalyst or activating agent, and THF/Hexane is the reaction mediumor solvent for the reaction. The end product is a star-shapedhigh-density contrast agent.

FIGS. 2A and 2B show the coupling reaction between any of the polyaminedendrimers with 2,3,5-triiodobenzoic acid chloride to yieldcorresponding dendritic iodine-containing contrast agent (A); and aschematic drawing of a dendritic polyamine up to level 4 (B) as used inthe present invention.

FIG. 3 shows the chemical structure of a level 1 polyamine dendriticderived high intensity iodine containing contrast agent.

FIG. 4 shows the chemical structure of a level 2 polyamine dendriticderived high intensity iodine containing contrast agent.

FIG. 5 shows the chemical structure of a Vacation 3 polyamine dendriticderived high intensity iodine containing contrast agent.

FIG. 6 shows the chemical structure of a Vacation 4 polyamine dendriticderived high intensity iodine containing contrast agent.

FIG. 7 shows the chemical structure of a commercially available watersoluble contrast agent known in the art under the trade name Ultravist®.

FIG. 8 shows the reaction of an Fmoc-protected polyhydroxyl compoundwith 2,3,5-triiodobenzoic acid chloride to yield a protected highdensity iodine-containing initiator.

FIG. 9 shows the deprotection reaction of compound in FIG. 8 to yieldthe high density iodine containing amine initiator.

FIG. 10 shows transformation of amine-terminated initiator to acarboxyl-ended contrast agent.

FIG. 11 shows the reaction between the compound synthesized in FIG. 9and lactide to yield a bioabsorbable polymer terminated with highdensity iodine contrast agent on one end (step 1); coupling reactionbetween carboxyl terminated initiator synthesized in FIG. 10 to yield abioabsorbable polylactide (PLA) terminated with high density iodinecontrast agent on both terminals (step 2).

FIGS. 12A and 12B show schematically the random orientation of polymerstrands/chains in a matrix (12A) and the aligned orientation of polymerstrands/chains in a polymer that has undergone orientrusion (12B).

FIG. 13 shows the chemical structure of exemplary dimers (glycolide,caprolactone, p-dioxanone, and trimethylene carbonate) used for makingbioabsorbable polymers and/or copolymers.

FIG. 14 shows the reaction between the compound synthesized in FIG. 9and glycolide (GA) to yield a bioabsorbable polymer terminated with highdensity iodine contrast agent on one end (step 1); coupling reactionbetween carboxyl terminated radiopaque compound synthesized in FIG. 10to yield a bioabsorbable polyglycolide (PGA) terminated with highdensity iodine contrast agents on both ends (step 2).

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

As shown in FIG. 1, when reacting pentaerythritol (100) with2,3,5-triiodobenzoic acid (200) in the presence of SOCl₂ (the catalyst)and THF/Hexane (the reaction medium), the resulting contrast agent (300)may have a high iodine content of 85%, almost twice as high ascommercially available agents (50) such as those under the trade nameUltravist® as shown in FIG. 7. In the reaction scheme, the number ofbenzoic acid moiety is denoted by m which is an integer between 1 and 4,depending on the completeness of the reaction. The number of unreactedhydroxyl group in the final compound is denoted by n, which is aninteger between 0 and 3, depending again on the completeness of thereaction. The sum of m and n, however, should always be 4 whichcorresponds to the number of hydroxyl groups in the startingpentaerythritol. FIG. 2A shows an exemplary coupling reaction between apolyamine-terminated dendrimer with 2,3,5-triiodobenzoic acid chlorideto yield a corresponding dendritic iodine containing contrast agents. Inthe reaction scheme, R′ denotes the portion of a dendrimer without the(NHR), portion as depicted in FIG. 3 (level 1 dendrimer in which n=2),in FIG. 4 (level 2 dendrimer in which n=4), in FIG. 5 (level 3 dendrimerin which n=8), and in FIG. 6 (level 4 dendrimer in which n=16). In thereaction scheme, n is the total number of amine groups in a startingdendrimer that can be utilized in the coupling reaction. The totalnumber of iodine atoms in each is 3n since each amine group after thereaction will yield 3 iodine atoms on the benzene ring. For example, forlevel 1 dendrimer in FIG. 3, there are 2 amine groups in the startingdendrimer. The final iodine atom is 3×2=6 after the conjugationreaction. Likewise, FIG. 4 shows the conjugation reaction of a level 2dendrimer and final dendritic contrast agent with 12 iodine atoms. FIG.5 shows a level 3 dendritic contrasting agent with 24 iodine atoms. FIG.6 shows a level 4 dendritic contrasting agent with 48 iodine atoms. FIG.2 b shows a generic chemical structure of a dendritic compound used inthe present invention with various levels denoted therein. Similarlydendrimers containing other functional groups such as carboxyl,hydroxyl, and sulfhydryl groups can also be used as the building blocksof high intensity contrast agents in accordance with this invention. Asshown for the chemical structure of a commercially available contrastagent (50), known under the trade name Ultravist® in FIG. 7, each suchmolecule only contains 3 iodine atoms covalently linked to the corebenzene ring. The I—C bonds are demonstrated to be stable underphysiological and irradiation conditions. The compound is mainlyeliminated through renal dialysis.

The Iopromide compound in Ultravist® has multiple hydroxyl groups thatmake it soluble in water. Although the water solubility of this agentmakes it suitable for use as an injectable contrast agent, it may notperform as well when used as a radiopaque coating or as a radiopaqueadditive in a polymer matrix. Such increase of side group makes theweight percentage of iodine in the molecule relatively low. In contrast,in accordance with the present invention, the linking of a multipletriiodobenzene ring structure to a core dendritic structure so theiodine content in each molecule is maximized can create a high intensitycontrast agent suitable as an radiopaque additive as both a coating andan additive to a polymer matrix as well as other uses known to thoseskilled in the art. As shown in FIG. 8, the simplest form of such a highiodine content contrast agent is synthesized through the reactionbetween a 9-fluorenylmethyl (Fmoc)-protected1-amino-2,2-dihydroxymethyl-3-propanol (110) and three2,3,5-triiodobenzoic acid chloride (210). In FIG. 8, m denotes thenumber of the triiodobenzene moiety in the final contrast agent and isan integer between 1 and 3. N is the unreacted hydroxymethyl group inthe final compound and is an integer between 0 and 2. The sum of m and nequals 3. When the reaction proceeds to completion, the resultingcontrast agent (310) has an iodine content of about 74%, much higherthan Ultravist's 48% (50). Additional advantages of a contrast agent inaccordance with the present invention are that all raw materials arereadily available and the coupling reactions generally have a highyield. Multiple layers of dendrimer cores may increase the cost, butthis may be offset by ever-higher iodine content and reduced amount ofthe required agent in the medical device to achieve adequate imagecontrast. Increased molecule weight also reduces the mobility andpotential of the contrast agent to leach out of the medical device.

Reacting a hydroxyl- or an amine-group containing compound and an iodinecontaining aromatic carboxylic acid or carboxylic acid chloride compoundwith a catalyst may be used to synthesize an iodine containing contrastagent. In accordance with the present invention this reaction isexpanded further by using a bi-, tri- or tetra-hydroxyl containingcompounds such as ethylene glycol, propylene glycol, glycerol, andpentaerythritol, bis-pentaerythritol to a single reactive contrast agentwith a multiple number of iodine atoms, which may result in maximizingthe radio-opacity of the molecule.

In-house research has showed that commercially available injectablecontrast agents such as those under the trade name Ultravist® (50)(Ultravist is a Registered Trademark of Schering AG) (iopromidecontaining 3 iodine atoms in each Ultravist molecule) demonstratedcomparable x-ray contrast to barium sulfate. The contrast agents inaccordance with the present invention have up to two times (2×) moreiodine atoms per unit weight of contrast agent, which may provide up toan estimated four times (4×) sharper contrast image quality. Inaddition, the proposed contrast agent is sparingly water-soluble andwould not swell the polymer matrix of the medical device and thus bettermaintain the mechanical properties of a medical device. In addition tolimiting the swelling, the leaching of the agent is also minimized.

In accordance with the present invention, multiple iodine molecules arebuilt into a single contrast agent resulting in maximizing theradio-opacity of the contrast agent. Moreover, because good solubilityof the contrast agent is present in common organic solvents, goodmiscibility may result with common polymers or polymer blends to formsolid solutions. Enhanced mechanical strength of the bulk materials ismaintained due to the elimination of crystalline additives which mayresult in stress risers, while relatively low water solubility ensureslong residence time and degradation rate of the bulk material.

Additional modifications in accordance with the present invention suchas use of various hydroxyl or amine containing functional molecules inthe reaction may be beneficial. Typical examples include, ethyleneglycol, propylene glycol, glycerol, pentaerythritol. Other functionalgroup containing compounds such as carboxyl groups, may be used for thesynthesis of the high intensity contrast agent compounds and naturallyderived amine or polyhydric alcohols such as sorbitol, trehelose etc.may be used to construct such a contrast agent and in addition mayprovide good biocompatibility. As previously indicated, variousprocessing methods such as solvent casting, dip coating, injectionmolding etc. may be used to mix the contrast agent and a bulk material.

In accordance with the present invention, compositions of a new class ofpolymeric high intensity X-ray contrast agents suitable for imagingimplanted medical devices such as a drug eluting stent are formulated.Protected polyhydric alcohol or amine containing organic compoundscommonly used in the synthesis of dendrimers may be used to react withan iodine containing aromatic compounds such as 2, 3, 5-triiodobenzoicacid to form such high iodine containing initiators. Each such initiatormay contain a multiple of three (3) iodine atoms. Upon deprotection ofFmoc group, as shown in FIG. 9, these iodine rich compounds possess afree amine group and can serve as an initiator for a ring openingreaction (ROP) of cyclic lactones such as lactide, glycolide etc. toform a bioabsorbable polymers. Other functional dimers such as adilactams, lactone such as caprolactone, mixed dilactones, mixedcyclophosphoester, trimethylene carbonate (TMC), may also be used in thereaction. Optionally as shown in FIG. 10, the amine end-capped initiatorcan be transformed to a carboxyl end-capped high iodine functionalmoiety by chloroacetic acid and later on used to cap the remaining endof a bioabsorbable polymer initiated with a iodine compound made in FIG.9. As shown in FIG. 11, the initiator created in FIG. 9 is then used toinitiate a cyclic dimmer through ROP to form a bioabsorbable polymerwith high iodine content on one end (410). The resulting polymer can befurther conjugated to a iodine containing compound created in FIG. 10 toyield a bioabsorbable polymer that have iodine atoms on both ends (510).This additional iodine containing moiety at the end of the polymerdoubles the iodine content in the final bioabsorbable polymer andfurther enhances the x-ray image contrast. Similarly di-functionaliodine rich compounds can be used in building other types of polymerssuch as polyurethanes and polyureas. The specific advantages of such acompound include but are not limited to: iodine containing bioabsorbablepolymers which behave like bioabsorbable polymers used to make thematrices of a medical device such as a drug eluting stent; thesecompounds are soluble in common organic solvents; the molecular weightand other properties of such iodine containing bioabsorbable polymerscan be adjusted to vary the degradation time, mechanical strength, andcontrast intensity per polymer; the iodine-containing polymers inaccordance with the present invention are miscible with the bulkmaterials used to construct a medical device, avoiding the change ofdegradation time and mechanical strength, and are not water-soluble anddo not leach out during the manufacturing processes and initialimplantation period.

FIGS. 12A and 12B show the orientation of polymer strands in a polymermatrix. Although the normal orientation of polymer chains in a polymermatrix (10) is random, one can impart a forces and/or processingconditions to create an alignment of the polymer chains within thestructure (11) that may result in anisotropic material properties andmay lead to improved material and/or mechanical properties. Inaccordance with the present invention, the polymers having highintensity contrast properties can be similarly processed to achieve thedesired mechanical properties.

Similarly, other commonly used cyclic dimers as shown in FIG. 13, forring opening reactions such as glycolide (GA), caprolactone (CL),p-Dioxanone (DO), trimethylene carbonate (TMC) can all be used in thepolymerizations alone or in mixture. Such dimers alone such as in FIG.14 showing an ring opening reaction of glycolide (GA) to yield abioabsorbable polyglycolide (PGA, 610), and end capping reaction with aniodine containing functional moiety to yield PGA (710) with 2×radiopaque density of 610. These cyclic dimmers may be used incombination with each other to adjust the physical and chemicalproperties of the final copolymers. These combinations are known to theskilled in the arts.

Additional embodiments and/or modifications include a series offunctional iodine or bromine containing initiators used to initiate thering opening reactions of a bioabsorbable polymer such as lactide,glycolide, caprolactone, or the mixture therein. Difunctional iodine orbromine rich compounds may serve as a building block of non-degradablepolymers such as polyurethanes and polyureas. These polymeric structurescan be further modified by having a biodegradable and/or biostablepolymer containing multiple iodine atoms at one end or both ends of thepolymer chains. This is accomplished by utilizing a process inaccordance with the present invention for end capping an iodine orbromine containing biodegradable and/or biostable polymer at the end ofthe reaction to double the iodine atoms in the polymer chain. Moreoverthis process in accordance with the present invention may be used toform X-ray visible bulk material of a medical device using such iodineor bromine containing bioabsorbable polymers providing the necessaryradiopacity. Alternately this process, in accordance with the presentinvention, for adding such iodine or bromine containing bioabsorbablepolymers may be used to enhance the X-ray contrast intensity of the bulkof the medical device. Furthermore one is not limited to bioabsorbablepolymers as this process, in accordance with the present invention, forusing such iodine or bromine containing non-degradable or biostablepolymers may be utilized to form X-ray visible bulk material of amedical device. The process in accordance with the present invention mayalso enhance the X-ray contrast intensity of the bulk of the medicaldevice by adding such iodine or bromine containing nondegradable orbiostable polymers to the bulk of the medical device.

A simple calculation of iodine content may show that with an iodine richcompound one has an iodine content of 72.7%. When incorporated into thefinal polymer with a degree of polymerization (DP) of 200 (molecularweight is ca. 30 KD), the iodine content in the final polymer isapproximately 3.81%, which is adequate for visibility under normal x-rayoperating conditions. If the final end-capping step in accordance withthe present invention is used, the iodine content in the final polymermay be doubled to 7.25%, achieving a value much higher than 3.0% to 5.0%iodine content needed for acceptable x-ray opacity. Alternatively, theMolecular weight of the polymer may be doubled to around 60 Kilo Daltons(KD) without adversely affecting the radiopacity since the polymer wouldstill have adequate X-ray opacity with the end-capping process of thepresent invention.

The method for introducing iodine or bromine atoms into each repeatingmonomer as disclosed in U.S. Pat. No. 6,475,477, (which is herebyincorporated by reference) may cause the property of bulk polymer tochange as a result of iodine or bromine introduction which isdistributed throughout the polymeric material. This series of patentswere also limited to iodine or bromine containing polycarbonates. Incomparison, the current method in accordance with the present inventionclusters iodine atoms and/or selectively locates the atoms at one end orboth ends of a polymer chain, leaving the bulk of the polymer chainsintact for its role as a medical device and thereby not producing achange in the properties of the bulk material which may affect deviceperformance.

This disclosed invention applies to both degradable and bioabsorbablepolymer synthesis as well as non-degradable/biostable polymers. Theincorporation of the high density radiopaque contrast agents can beadded to a biostable polymer through grafting polymerization or plasmagrafting processes. The X-ray opaque polymers may be further processedinto different forms and shapes as medical devices providing the bulkmaterial from which the end product or device is formed. The polymersmay also be used as a polymeric coating or a drug release barrier fordevice drug combination products or to simply enhance the radiopacity ofthe device for which the material is coated upon or incorporated within.

The reaction between a hydroxyl group containing compound and an iodinecontaining aromatic compound may be processed for synthesizing an iodinecontaining contrast agent. This invention expands the concept furtherand used a protected bi-, tri- or tetra-hydroxyl containing compounds tomake a functional initiator. Upon deprotection of Fmoc(9-fluorenylmethoxycarbonyl) as shown in FIG. 9, the initiator can beused to initiate a ring opening reaction of cyclic lactones such aslactide, glycolide to form an iodine-containing polymer. Other commonlyused protecting groups for amine and hydroxyl groups, other than Fmoc,such as Boc-, Z-, Ddz-, tert.-Butyl, Cbz, may be expressly used tosubstitute for Fmoc as a suitable protecting group in the reaction. Thering opening reaction is well researched and used in production of otherbiocompatible materials such as resorbable sutures. The finalend-capping step as shown in FIGS. 11 and 13 is a variation of regularend capping of a methanol, to impart more iodine content of thebioabsorbable polymer.

In accordance with the present invention, multiple iodine molecules arebuilt into a single initiator of a ring opening reaction. Abioabsorbable polymer contains a large number of iodine atoms withoutsacrificing the mechanical properties of the bulk materials, forexample, such a bioabsorbable polymer may contain twice the number ofiodine atoms by end capping with a derivative of the iodine containingfunctional initiator. Such iodine containing bioabsorbable polymer canbe blended with regular bulk materials to form a medical device withmuch enhanced x-ray contrast and is non-leachable during the processingand initial period of implantation, ensuring desired degradation andbiocompatibility. Furthermore, the contrast intensity of the medicaldevice can be adjusted by varying the molecular weight and thepercentage of the iodine-containing polymer in the matrices. This iodineintroduction method may be used for synthesis of radiopaquenon-degradable polymer as well in accordance with the present invention.

Modifications include use of various hydroxyl or amine containingfunctional molecules, which upon proper protection, can be used in thesynthesis of the functional initiator. Upon deprotection, thesefunctional initiators can be transformed into corresponding end cappingiodine containing functional compounds. Any commonly monomers forbioabsorbable polymers such as lactide, glycolide, caprolactone,dioxanone, trimethylene carbonate, etc., or the combination of thesemonomers, can be used to construct the iodine-containing degradablepolymers. Non-degradable polymers such as polyurethanes or polyureas mayalso be made more radiopaque using the same or similar chemistry such aschemical or plasma grafting reactions.

Although what has been shown and described is what is believed to be themost practical and preferred embodiment of the present invention, otherforms of, and departures from the specific designs described and shown,will suggest themselves to those skilled in the art and may be usedwithout departing from the spirit, scope or essential characteristics ofthe present invention. The present invention is not restricted orlimited to the foregoing described embodiments, but rather should beconstructed to cohere with all variations, combinations, andmodifications that may fall within the scope of the appended claims.

1. A compound having the formula: R—NHFmoc, wherein R is

and m is an integer between 1 and 3, n is an integer between 0 and 2,and m+n=3, X is a halogen atom selected from Iodine, Bromine andChlorine.
 2. A preferred compound of claim 1 wherein X is Iodine and mis 3 and n is
 0. 3. A compound having the formula: R—NH₂, wherein R is:

and m is an integer between 1 and 3, n is an integer between 0 and 2,and m+n=3, and X is a halogen atom selected from Iodine, Bromine andChlorine.
 4. A compound of claim 3 wherein X is Iodine and m is 3 and nis
 0. 5. A compound having the formula: R—NH—R″, wherein R is

and m is an integer between 1 and 3, n is an integer between 0 and 2,and m+n=3; X is a halogen atom selected from Iodine, Bromine andChlorine; and R′ is a bioabsorbable polymer synthesized via aring-opening polymerization using R—NH₂ as an initiator.
 6. A compoundof claim 5 wherein X is Iodine and m is 3 and n is
 0. 7. A compoundhaving the formula: RNH—R′—NHR wherein R is

and m is an integer between 1 and 3, n is an integer between 0 and 2,and m+n=3, X is a halogen atom selected from Iodine, Bromine andChlorine, and R′ is a bioabsorbable polymer synthesized via aring-opening polymerization using R—NH₂ as an initiator and end-cappedby RNH₂ through a coupling reaction.
 8. A compound of claim 7 wherein Xis Iodine and m is 3 and n is
 0. 9. A compound of claim 7 where R′ is ahomolopolymer or a copolymer synthesized via a ring-openingpolymerization from monomers selected from lactide, glycolide,caprolactone, dioxanone, trimethylene carbonate.